Of sex and science. Elizabeth Pisani's blog about HIV and other sundry things.

26/04/08

The World Bank and others plan to bribe young Tanzanians to stay HIV negative, according to Andrew Jack, writing in The Financial Times.

We know blackmail can work pretty well in HIV prevention. When brothel-owners in Thailand were told their businesses would be shut down if they didn’t ensure clients used condoms, condom use shot past 90 percent and HIV and other sexually transmitted infections came crashing down. The programme succeeded because it threatened to hit brothel owners where it hurt — in the pocket. If someone is motivated by cash then you can manipulate them with cash incentives. That’s the thinking behind the Tanzanian programme, too. According to an FT editorial:

“the cash may increase the bargaining power of young women and give them an alternative to accepting money from richer, older boyfriends.”

Maybe — US$ 45 is a lot of money for a 17 year-old girl in Tanzania. But I worry that it won’t work as a bribe. We’ve painted ourselves into a corner of thinking that young women in Africa only have risky sex with older men because they want money. But I suspect young women in Africa like older men for the same reasons as young women elsewhere do — prestige, the kick of being shown off to the guy’s friends as a “trophy”, the kick of showing him off to her own friends as ditto, visits to nightclubs, rides in nice cars. Oh, and better sex that you usually get from some spotty guy your own age. Those are not things that you easily give up for the indignity of regular STI tests and a couple of cash payments.

Still, no harm in trying. And at least this is being set up as a trial, so that areas that bribe can be compared with areas that don’t bribe. I’m curious, though, that the researchers wanting to see if bribery can cut HIV transmission have decided not to measure HIV. They’re apparently going to judge the programme a success (and dole out cash) based on negative tests for other (curable) sexually transmitted infections such as gonorrhoea. Which rather makes me think that we might see a spike in sales of azithromycin and other gono drugs just before people go in to pick up their bribes.